Charoenchue Puwitch, Na Chiangmai Wittanee, Amantakul Amonlaya, Wanchaitanawong Wasuwit, Chitapanarux Taned, Pojchamarnwiputh Suwalee
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Int J Biomed Imaging. 2023 Sep 15;2023:7938732. doi: 10.1155/2023/7938732. eCollection 2023.
This study is aimed at evaluating the diagnostic performance of clinical predictors and the Doppler ultrasonography in predicting esophageal varices (EV) in patients with hepatitis C-related cirrhosis and exploring the practical predictors of EV.
We conducted a prospective study from July 2020 to January 2021, enrolling 65 patients with mild hepatitis C-related cirrhosis. We obtained clinical data and performed grayscale and the Doppler ultrasound to explore the predictors of EV. Esophagogastroduodenoscopy (EGD) was performed as the reference test by the gastroenterologist within a week.
The prevalence of EV in the study was 41.5%. Multivariable regression analysis revealed that gender (female, OR = 4.04, = 0.02), platelet count (<150000 per ml, OR = 3.13, = 0.09), splenic length (>11 cm, OR = 3.64, = 0.02), and absent right hepatic vein (RHV) triphasicity (OR = 3.15, = 0.03) were significant predictors of EV. However, the diagnostic accuracy indices for isolated predictors were not good (AUROC = 0.63-0.66). A combination of these four predictors increases the diagnostic accuracy in predicting the presence of EV (AUROC = 0.80, 95% CI 0.69-0.91). Furthermore, the Doppler assessment of the right hepatic vein waveform showed good reproducibility ( = 0.76).
Combining clinical and Doppler ultrasound features can be used as a screening test for predicting the presence of EV in patients with hepatitis C-related cirrhosis. The practical predictors identified in this study could serve as an alternative to invasive EGD in EV diagnosis. Further studies are needed to explore the diagnostic accuracy of additional noninvasive predictors, such as elastography, to improve EV screening.
本研究旨在评估临床预测指标和多普勒超声在预测丙型肝炎相关肝硬化患者食管静脉曲张（EV）方面的诊断性能，并探索EV的实用预测指标。
我们于2020年7月至2021年1月进行了一项前瞻性研究，纳入65例轻度丙型肝炎相关肝硬化患者。我们获取了临床数据，并进行了灰阶和多普勒超声检查以探索EV的预测指标。由胃肠病学家在一周内进行食管胃十二指肠镜检查（EGD）作为参考检测。
本研究中EV的患病率为41.5%。多变量回归分析显示，性别（女性，OR = 4.04，P = 0.02）、血小板计数（每毫升<150000，OR = 3.13，P = 0.09）、脾长度（>11 cm，OR = 3.64，P = 0.02）以及右肝静脉（RHV）三相波消失（OR = 3.15，P = 0.03）是EV的显著预测指标。然而，单个预测指标的诊断准确性指标并不理想（AUROC = 0.63 - 0.66）。这四个预测指标联合使用可提高预测EV存在的诊断准确性（AUROC = 0.80，95% CI 0.69 - 0.91）。此外，右肝静脉波形的多普勒评估显示出良好的可重复性（κ = 0.76）。
结合临床和多普勒超声特征可作为预测丙型肝炎相关肝硬化患者EV存在的筛查试验。本研究中确定的实用预测指标可作为EV诊断中侵入性EGD的替代方法。需要进一步研究探索其他非侵入性预测指标（如弹性成像）的诊断准确性，以改善EV筛查。
